A case of penetrated ulcer in transverse colon presenting antral stenosis due to retraction of lesser and greater omentum

A patient with acute gastric dilatation due to antral stenosis underwent surgery, and it was revealed that stenosis was induced by retraction of the lesser and greater omentums resulting from colonic ulcer penetration. A 72- year-old female was admitted due to complaints of upper abdominal pain and nausea. Radiological study of the upper gastrointestinal tract revealed severe stenosis of the antrum, but endoscopic examination could not confirm the lesion. Operation was performed after a diagnosis of suspicious gastric cancer. Laparotomy revealed a stenotic lesion of the left side of the transverse colon which induced retraction of the lesser and greater omentums, forming an antral stenosis. Resection of the transverse colon was done, and a circular ulcer with a sharp margin penetrating to the serosal layer was observed in the resected specimen. Histological examination revealed a UL 1 ulcer with granulation and inflammatory cell infiltration without malignancy. Sedimentation of hemosiderin, thrombosis of the smaller vessels, and hypertrophy of the internal membrane of the vessels were also observed. Ischemic mechanism was suggested to be associated with the formation of the ulcer.